Healthcare Provider Details

I. General information

NPI: 1578147666
Provider Name (Legal Business Name): TRI-COUNTY COMMUNITY ACTION AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

IV. Provider business mailing address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-2750
  • Fax: 401-351-6611
Mailing address:
  • Phone: 401-351-2750
  • Fax: 401-351-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH R DESANTIS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 401-519-1976